Midwifery Care
Homebirth Services

Vaginal Birth After Cesarean (VBAC)

After a steady decline in cesarean section rates and a correlative rise in VBACs in the late 80s through the 90s the U.S. is now suffering an extreme reversal of these trends. Following an American College of Obstetrics and Gynecology recommendation that all attempted VBACs take place in a hospital capable of performing an emergency c-section in a very short period of time due to the perceived increase in uterine rupture rates for VBACs, many physicians and hospitals have chosen to deny their clients the option for VBAC.

This despite the fact that numerous studies have indicated that the increase in uterine ruptures is less than 1%. Indeed a recent study states that there is no significant difference in rupture rates after one or two previous c-sections (0.8% and 0.9% respectively). The one factor that may prove to be significant in assessing the risk of uterine rupture is whether or not an induction occurred, particularly where Cytotec has been used. It has also been suggested that single-layer suturing of the uterus vs. double-layer could predispose women to a higher rupture rate while attempting a VBAC.

Given the growing body of information regarding the safety of VBAC over repeat c-section, I believe that VBAC at home is a reasonable option for most women. As with any other possible complication of birth, a trained midwife will be alert and capable of recognizing the warning signs in nearly all situations. At which point a safe transport to the nearest hospital will take place.

Many reasons are sited for needing a c-section, some of which are absolutely valid and some which beg further scrutiny. Sometimes it is the exact medical care that was intended to get a baby born safely that can lead to the need for a c-section. Induction of labor, artificially breaking the bag of waters, epidurals, continuous electronic fetal monitors and lying on your back can all lead to circumstances that necessitate a c-section.

One researcher recently examined all the possible causes for a c-section and found that there has been no significant change in any of these factors in the past 20 years, and yet the national c-section rate in 2005 was 29.1% with an expected increase in the years to follow. Although we have more than doubled the c-section rate in 30 years we have not lowered the infant morbidity or mortality rates. The researcher concludes that the rise in c-sections is based solely on physician discretions which appear to be led by a fear of litigation.

Every woman and baby has a right to a vaginal birth. When it has proven unattainable for one birth it does not mean it will be so for the next. Obstetricians who are still granting attempts at VBAC state a 70% success rate. Not too bad, yet the rate of successful home VBAC is well over 80%. I believe this difference is due in part to a midwife's strong conviction in a woman's ability to birth naturally. While OBs let you "try", midwives assume you will. Furthermore a woman is much less likely to experience any interventions at home that would lead to a repeat c-section. I have an inherent trust in birth and choose not to intervene unless absolutely necessary. Probably of greatest importance to women choosing a VBAC, is my belief that induction is almost always unnecessary and even unwise. Time to allow both mom and baby to prepare for the rigors of labor is of utmost importance.

There is nothing more profound than witnessing the joy, relief and fulfillment on a woman's face as she reaches for her new baby after a successful VBAC. These can be such healing moments for the entire family. And for those women who ultimately birth via c-section again, there has been comfort in knowing that with a trusted and skilled midwife by their side, they have truly given it their all. I am grateful for the many opportunities to serve VBAC women, to see their strength, courage, determination, disappointment, tears of both joy and regret, relief and rage, and to welcome the little ones who come with their own stories in their own time and on their own terms.